blossom wrote:what is the nut cracker syndrome?
Dr. Sclafani wrote:I now image the left renal vein in all cases because of the great blood flow within it. When there are outflow problems with this vein, a major collateral circuit is to the ascending lumbar vein (increasing flow through vertebral plexus) and to the hemiazygous vein (contributing greatly to the azygous system. There are two anomalies that typically obstruct left renal vein outflow: the nutcracker compression of the vein between the superior mesenteric artery and the abdominal aorta and retroaortic renal vein that can get compressed against the spine and back.
The image on the left shows the catheter going from the inferior vena cava into the left renal vein. There is an area of minimal xray dye in the middle of the renal vein. The gree curved arrow points to the ovarian vein. It is not common to see so much contrast media entering it. The next image shows that in addition to the gonadal vein, there is reflux into the ascending lumbar vein (orange arrow) and the hemiazygous vein (yellow arrow). THIS IS NOT NORMAL. The image on the right is an IVUS image of the renal vein. The renal vein is compressed (red arrows). I bet Nutcracker syndrome. Does treatment of this syndrome improve symptoms of ccsvi? I will review soon another patient who had already been treated for CCSVI (BUT NOT NUTCRACKER) who has already shown improvements of the prior CCSVI treatment.
Does severe nutcracker phenomenon cause pediatric chronic fatigue?
Auteur(s) / Author(s)
TAKAHASHI Y. (1) ; OHTA S. (1) ; SANO A. (2) ; KURODA Y. (2) ; KAJI Y. (3) ; MATSUKI M. (3) ; MATSUO M. (3) ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
(1) Department of Pediatrics, Tenri Hospital, Nara, JAPON
(2) Department of Radiology, Tenri Hospital, Nara, JAPON
(3) MR center, Tenri Hospital, Nara, JAPON
Résumé / Abstract
Background: In the past five years we experienced 9 fatigued disabled children who were intermittently or persistently absent from school. Patients: They had been suspected to be burdened with psychosomatic disorders, having orthostatic hypotension, postural tachycardia, or other autonomic dysfunction symptoms. Results: Investigating the cause of moderate orthostatic proteinuria in some of them, we found by chance severe typical nutcracker phenomenon (NC), which was present in all 9 children complaining of chronic fatigue. Conclusion: Their symptoms filled the criteria of chronic fatigue syndrome or idiopathic chronic fatigue (CFS/CF). An association between severe NC and autonomic dysfunction symptoms in children with CFS/CF has been presented.
Chronic fatigue syndrome and fatigue symptoms have been associated with NCS with high LRV-IVC pressure gradients.19,66,68 Fatigue symptoms correlated positively with high peak velocity (PV) ratios by DUS and improved in some patients after surgery, balloon angioplasty, or aspirin therapy.3,68,69
Clin Nephrol. 2000 Jan;53(1):77-8.
An effective "transluminal balloon angioplasty" therapy for pediatric chronic fatigue syndrome with nutcracker phenomenon.
Takahashi Y, Sano A, Matsuo M.
Med Hypotheses. 2007;69(3):704-5. Epub 2007 Feb 27.
Can chronic fatigue symptoms associated with nutcracker phenomenon be treated with aspirin?
Shin JI, Lee JS.
Radiology. 1978 May ;127 (2):351-6 644057 Cit:1
Renal vein valves: incidence and significance.
C F Beckmann, H L Abrams
Although autopsy studies have demonstrated valves in 28-70% of right and 4-36% of left renal veins, they have rarely been detected or described during life. In an analysis of 98 renal venograms, valves were found in 16% of patients on the right side and in 15% on the left, without predilection for any particular location. Angiographically, they appeared as thin, web-like structures which may block passage of the catheter or of contrast material, and hence cause poor venographic filling. Rarely, valves produce total obstruction to the retrograde flow of contrast material.
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